Glaucoma – Screening and Stable Monitoring Service

Glaucoma – Screening and Stable Monitoring Service


Glaucoma is a group of diseases, mainly characterized by damage to the optic nerve. This is often, but not always associated with raised pressure within the eye. In the earlier stages, and milder glaucoma, this is undetectable by the patient. The pressure damages the optic nerve, and that progressively damages the peripheral vision. In this photograph we can see the optic nerve with signs of glaucoma damage and this progresses, this can damage the peripheral field of vision, and in the mild and early stages of the disease, this is not detectable by the patient. The range of patients that we see at Moorfields varies very greatly from very mild, very stable disease which will not affect the vision in the lifetime of that patient, to very complex disease, which might require frequent changes of medication. For patients who have very mild and stable disease, we often monitor them 6-12 monthly. For more severe disease, or disease that’s progressing more rapidly, we will monitor the patients much more frequently. Early detection and treatment can stabilise and minimise the progression of the disease. The purpose of the screening and stable monitoring service is to reduce patient waiting times within the glaucoma service and have an effectively a more streamlined approach to our patients’ care whilst ensuring that the relevant tests are completed properly. The key aim, really, is to improve the patients’ experience within the glaucoma service. So the clinic is run by specialist trained Ophthalmic Technicians who undertake all the relevant tests that are appropriate for detecting and monitoring glaucoma. The patients who are selected to go into the clinic have been identified by their Consultant Ophthalmologist, and generally speaking these are low-risk new patients or low-risk stable patients who have been attending the general glaucoma outpatients service for a number of years. All the tests are done in a dedicated area within the hospital. And on average the patient journey time is about 45 minutes to an hour. Now that may seem like a long time but we do have to do all the relevant clinical tests so that the consultant has enough information to make a clinical decision on their patients. Our clinic is slightly different to that of the general outpatients clinic because we don’t actually have a clinic receptionist. The patients are asked to come in and have a seat in the waiting area and someone will come out and deal with them as they arrive. When the patient has completed a pre-test questionnaire, we will bring them into the facility and we will first of all check their distance vision using a computerized test chart. Once we’ve tested their vision, we’ll then do a field of vision test. The patients who’ve been attending the glaucoma service for a number of years will be familiar with this test but essentially what we’re doing is examining the peripheral vision of our patients, and who do 1 eye at a time. Once we’ve completed the field of vision test we then walk the patient to the pressure testing device. This is an integral part of the glaucoma assessment, measuring the patients’ eye pressure and we do that with a slightly newer device than what’s generally done in the glaucoma outpatient clinic. Once we’ve measured the patient’s interocular pressure we then take them to our imaging devices and we have 2. They image the back of the eye in slightly different ways and they give the consultant extra information about the appearance of the patient’s optic nerve head and the surrounding area. After all these tests have been done the patient will then have a short interview, and in that interview, they’ll determine if the patient’s having any problems or how they’re getting on with their medication and other relevant things to their condition and after that the patient can then leave. So once all the tests have been done, all the information is uploaded to the patient’s electronic record which means that the consultant can review their data at any place where there is a computer terminal and internet connection. Once the consultant has made their decision about the patient’s stability he will then write them a letter which is copied to both the patient and their GP, and we aim to get letters out to patients and their GPs within 2 weeks of the appointment.

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